Excerpts from the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD

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Many ESPAD questions were modeled after Monitoring the Future, making U.S. comparisons possible. Therefore, U.S. data are entered into the tables and figures of the report only when there is total or close comparability. What follows are excerpts from the full report, reprinted with permission, showing tables and figures that allow comparison with MTF data.

Summary of the 2003 findings

Data on young people’s alcohol and drug habits have been collected in three waves of the European School Survey Project on Alcohol and Other Drugs, ESPAD. The first study was conducted in 26 countries in 1995. The second survey was done in 1999 and reached 30 participating countries. The focus of this chapter is on the findings from the surveys that were performed in 35 countries in 2003. The participating countries include Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroe Islands, Finland, France, Germany (6 Bundesländer), Greece, Greenland, Hungary, Iceland, Ireland, Isle of Man, Italy, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Russia (Moscow), the Slovak Republic, Slovenia, Sweden, Switzerland, Turkey (6 cities), Ukraine and the United Kingdom. The project is a collaborative project between independent research teams in the participating countries. More than 100,000 students participated in the 2003 data collection. In this chapter a short version of the 2003 findings is presented. Key data on important variables are presented in summary tables 1–3. The behaviours included are cigarette smoking, alcohol consumption, drunkenness and use of illicit drugs.

The students answered the questionnaires anonymously in the classroom under conditions similar to a written test. The sample sizes in participating countries ranges between 555 in Greenland to almost 6,000 in Poland. However, small study groups are only found in small countries where no sampling was done. In all remaining countries, the sample size was close to or above the recommended number of 2,400. The results of the survey were reported in a standardised format. These country reports form the basis of the content of this report.

Data quality
Every effort was made to standardise the methodology of the ESPAD project across countries. Nevertheless, some methodological issues inevitably arise in a comparative survey of 35 countries. The validity is deemed to be high in most ESPAD countries. The cultural context in which the students have answered the questions has most probably differed between countries. However, this does not necessarily indicate large differences in the willingness to give honest answers. A few countries have experienced modest validity problems, but such problems are not of the magnitude necessary to seriously threaten the comparability of results. For various reasons it was not possible to give precise levels of statistical significance in this report. Small differences in point estimates between countries or over time should therefore be interpreted with caution. However, given the size of the national samples and the sampling methods employed, differences of more than a few percentage points can with considerable confidence be considered significant.

Methodology
As in earlier studies, the surveys were conducted with a standardised methodology and a common questionnaire to provide as comparable data as possible. Data were mainly collected during Spring 2003 and the target population was students born in 1987. Thus, the age group studied turned 16 during the year of data collection. At the time of the data collections the average age was 15.8 years. Data were collected by group-administered questionnaires in schools on nationally representative samples of classes. Exceptions include Russia, where the study was restricted to Moscow only, Germany, where the study was performed in six Bundesländer and Turkey, where the study was restricted to six major cities in the six main regions in Turkey. Teachers or research assistants collected the data.

Tobacco
he use of cigarettes 40 times or more in lifetime and the 30 days prevalence rates are presented in the summary tables. In nearly all ESPAD countries 50–80% of the students had smoked cigarettes at least once in their lifetime, and those who had smoked 40 times or more are mainly found in countries where the lifetime prevalence is high. In

Summary of the 2003 findings

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Austria, the Czech Republic, the Faroe Islands, Greenland, Germany, Lithuania and Russia (Moscow) about 40% had smoked 40 times or more in their lifetime. The lowest prevalence rates are found in Turkey (13%), Malta (16%), Iceland and Portugal (18% each). In eight of the 35 ESPAD countries more boys than girls had smoked 40 times or more in their lifetime. These countries are mainly found in the eastern parts of Europe such as Estonia, Latvia, Lithuania, Poland, Romania and Ukraine, but also in Cyprus and Turkey. Large differences in the other direction with more girls reporting this behaviour are mainly found in two northern islands, Greenland and the Isle of Man. The highest percentage of students, which reported smoking during the last 30 days is found in Greenland, which stands apart from other countries on this variable (60%). High rates are also found in Austria, Bulgaria, Germany, Russia (Moscow) and the Czech Republic (43–49%). Particularly low proportions are found in Cyprus, Iceland, Sweden and Turkey with figures ranging between 18 and 25%. Countries with substantially higher rates of last month smoking among boys include Cyprus, Latvia, Lithuania, Turkey and Ukraine. Considerably higher rates among girls are found in Greenland, Ireland, Isle of Man and the United Kingdom.

Alcohol consumption
Prevalence of alcohol consumption 40 times or more in lifetime is presented in the summary tables. They also contain the 30 days prevalence of alcohol consumption 10 times or more, as well as the 30 days prevalence of consuming beer, wine and spirits 3 times or more. In two thirds of the ESPAD countries the vast majority (90% or more) of the students have drank alcohol at least once in their lifetime. However, these students do not all drink on a regular basis. A student who has been drinking at least 40 times can be labelled as more of a regular consumer. The prevalence rates of this frequency of drinking are much lower than the total lifetime prevalence. The highest rates reporting use of alcohol 40 times or more in lifetime are primarily found in the same countries as reported the highest lifetime figures. They include Denmark, Austria, the Czech Republic, Isle of Man, the Netherlands and the United Kingdom (43–50%). The lowest proportion is reported from Turkey (7%) followed by Greenland, Iceland, Norway and Portugal (13–15%).

More boys than girls report this level of alcohol consumption. In a few countries, Isle of Man, Fin land and Norway, the gender distribution is about equal. However, no country reports prevalence rates among girls that exceed those of the boys. A higher frequency of alcohol use is revealed among students who had consumed alcohol 10 times or more during the last 30 days, i.e. at least every third day on average. About one quarter of the students in the Netherlands (25%) and about one fifth of the respondents in Austria, Belgium, Malta and the United Kingdom (17–21%) reported this frequency of alcohol use. In some countries, this drinking frequency is hardly reported at all. Proportions of 3% or less were found in Finland, Greenland, Iceland, Norway and Sweden. Thus, the very low prevalence rates are mainly concentrated to the Nordic countries. Many students report rather frequent beer consumption. The percentages of students who had consumed beer 3 times or more during the last 30 days varies between 10 and 44%. The highest figures are found in Denmark, Bulgaria, the Netherlands and Poland (40–44%). The smallest proportions were reported from Norway and Turkey (10 and 14% respectively). Other countries where less than 20% had consumed beer that often include Finland, Hungary, Iceland and Portugal. Drinking beer is a predominantly male behaviour in most ESPAD countries. The only exceptions are two countries in the North Atlantic, Greenland and Iceland, where almost equal proportions of girls and boys report frequent beer drinking. A smaller number of students had been drinking wine than beer during the last 30 days. The proportions of students reporting a wine consumption frequency of 3 times or more during last 30 days are in most cases lower than 20%. However, one country stands out in this respect, as one third (35%) of the students in Malta reported this frequency of wine drinking. Other high prevalence countries include Austria, the Czech Republic, Greece, Italy and Slovenia (21–23%). The lowest proportions that reported this frequency of wine consumption are found in Finland, Iceland, Norway and Turkey (5% or less). The number of students who had been drinking spirits during the last 30 days vary considerably between the ESPAD countries. This also holds true also when looking at the number of students who had been drinking 3 times or more during last month. The British Isles are at the top but also two

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Summary of the 2003 findings

Mediterranean countries. The highest proportion is found in Malta, where 43% of the students reported this frequency of spirits consumption. The countries that come next include the Faroe Islands, Greece, Ireland, Isle of Man and the United Kingdom (37–39%). In about half of the countries, more boys than girls report such frequent consumption of spirits. However, almost the same number of countries report prevalence rates that are equal or almost equal between the sexes. Only three countries report proportions among the girls that exceed those of the boys. These countries are all high frequency countries and they are all parts of the British Isles, i.e. Ireland, Isle of Man and the United Kingdom.

reported from Cyprus, France, Greece, Portugal and Turkey (1–4%).

Binge drinking
The frequency of having 5 or more drinks in a row, sometimes referred to as “binge drinking”, provides an alternative measure of heavy alcohol use. The proportion indicating such consumption 3 times or more during the last 30 days vary considerably over the ESPAD countries. This is reported by one fifth to one third of the students in about half of the ESPAD countries. The highest number of students reporting this behaviour is found in Denmark, Ireland, Isle of Man, Malta, the Netherlands, Norway, Poland and the United Kingdom (24–32%). Thus, there is a concentration of countries to the northern and western parts of Europe with Malta as the only exception. Countries with the lowest binge drinking figures are Cyprus, France, Greece, Hungary, Iceland, Romania and Turkey (5–11%).

Drunkenness
Lifetime prevalence of having been drunk 20 times or more and the 30 days prevalence of being drunk 3 times or more are presented in the summary tables. Some students have a rather limited experience of getting drunk, while others get intoxicated more frequently. However, in 30 of the 35 countries studied a majority of the students have been drunk at least once. The countries with the highest percentages indicating that they had been drunk 20 times or more in lifetime include Denmark, Ireland, Isle of Man, the United Kingdom, Estonia and Finland (26–36%). In other countries only a few report this frequency of drunkenness. In Turkey only 1% had been drunk 20 times or more and in Cyprus, France, Greece and Portugal this was reported by about 3% of the students. In a majority of the countries there are more boys than girls that report this frequency of intoxication. In no country are the girls in majority. However, in relatively many countries the gender distribution is rather even. These countries include both the British Isles and most of the Nordic countries (Finland, the Faroe Islands, Iceland, Ireland, Isle of Man, Norway, Sweden and the United Kingdom). The number of students who have been drunk 3 times or more during the last 30 days is of course much smaller, but the highest ranked countries are in most cases the same. Thus, in Denmark and Ireland about one fourth of the students had been drunk that often. Other countries with high prevalence rates include Isle of Man and the United Kingdom. However, in about half of the ESPAD countries the number of students reporting this frequency of intoxication is 10% or less. The lowest figures are

Illicit drugs
Lifetime use of various illicit drugs are presented in the summary tables, including cannabis, amphetamines, LSD, Ecstasy, tranquillisers or sedatives without a doctor’s prescription and the use of inhalants. In addition the 30 days prevalence of cannabis is included. The vast majority of students in all ESPAD countries that have tried any illicit drug have used marijuana or hashish. Thus, the number of students reporting cannabis use is almost identical with the total illicit drug prevalence. The top country in this respect is the Czech Republic where 44% of the students have used marijuana or hashish. High prevalence rates are also reported in France, Ireland, Isle of Man, Switzerland and the United Kingdom (38–40%). Other countries where more than one fourth have used cannabis include Belgium, Germany, Greenland, Italy, the Netherlands, the Slovak Republic and Slovenia (27–32%). The lowest levels are reported in Cyprus, Greece, Sweden, Romania and Turkey (3–7%), but also in the Faroe Islands, Finland and Norway (around 10%). The use of cannabis during the last 30 days may indicate regular use. In some countries about one fifth of the students report this, in others much lower prevalence rates are noted. The countries with the highest 30 days prevalence include the Czech Republic, France, Isle of Man, Switzerland and the United Kingdom (19–22%).

Summary of the 2003 findings

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In most ESPAD countries there are more boys than girls who have used cannabis. However, the gender differences are small in Bulgaria, Croatia, Greenland, Hungary, Iceland, Ireland, Russia (Moscow) the Slovak Republic and Slovenia. The countries with the highest percentages of students reporting use of amphetamines are Estonia, Germany, Iceland, Lithuania and Poland (5– 7%). In 13 countries 1% or less reported use of amphetamines. The ESPAD students do not use LSD very frequently. The highest percentages are found in the Czech Republic and Isle of Man where 5–6% reported such use. Ecstasy is the most used drug of those included in the questionnaire apart from cannabis. In the Czech Republic 8% had used it, followed by Croatia, Estonia, Ireland, Isle of Man, the Netherlands and the United Kingdom (5–7%). Tranquillisers or sedatives can be used both as a legally prescribed medicine and as an illicit drug. The use of such substances without prescription is most common in Poland (17%) followed by Lithuania (14%), France and the Czech Republic (11– 13%). The lowest prevalence rates are found in Austria, Bulgaria, Germany, Ireland, Ukraine and the United Kingdom (2% each). The highest prevalence of inhalants is reported in Greenland, where 22% had ever used them. Other countries with high levels of inhalant use include Cyprus, Greece, Ireland, Isle of Man, Malta and Slovenia (15–19%). Very small gender differences are found in relation to the use of inhalants. In a majority of the countries there are no gender differences, but in Belgium, Cyprus, Greece, Portugal and Ukraine more boys than girls reported this behaviour. Girls

only reported more use than boys in one country, Ireland.

Conclusions
In summary, the pattern of alcohol consumption reveals that frequent drinking is most prevalent among students in the western parts of Europe, such as the British Isles, the Netherlands, Belgium but also in Austria, the Czech Republic and Malta. Very few students in the northern parts of Europe drink that often. Beer consumption is most prevalent in Bulgaria, Denmark, the Netherlands and Poland, while wine consumption is most prevalent in typical wine producing countries such as Austria, the Czech Republic, Greece, Italy, Malta and Slovenia. The consumption of spirits is less uniform, with high prevalence rates in as disparate countries as the Faroe Islands, Greece, Ireland, Isle of Man, Malta and the United Kingdom. The prevalence of drunkenness seem to be most concentrated to countries in the western parts of Europe, such as Denmark, Ireland, Isle of Man and the United Kingdom. Very few students report frequent drunkenness in Mediterranean countries such as Cyprus, France, Greece, Portugal, Romania and Turkey. The illicit drug use is dominated by use of marijuana or hashish. Frequent use is mainly reported from countries in the central and western parts of Europe, where more than one third of the students have used it. The high prevalence countries include the Czech Republic, France, Ireland, Isle of Man, Switzerland and the United Kingdom. The low prevalence countries are found in the north as well as the south of Europe.

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Summary of the 2003 findings